Provider Demographics
NPI:1891599429
Name:HENLEY, TAYLOR MADISON (APRN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MADISON
Last Name:HENLEY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 E SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1511
Mailing Address - Country:US
Mailing Address - Phone:731-435-0531
Mailing Address - Fax:
Practice Address - Street 1:8 STONEBRIDGE BLVD STE H8
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2178
Practice Address - Country:US
Practice Address - Phone:731-257-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38279363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health